Moving us from the absence of harm, to the presence of safety

Achieving meaningful improvement in the hullabaloo of frontline services is tough. Change is hard. Accumulating the theoretical knowledge and motivation is one thing. Having the tenacity to engage, challenge, overcome and sustain is a different and altogether more daunting (yet rewarding) challenge.

One of the more common phrases you will hear when seeking to engage others in change is ‘I haven’t got capacity’. ‘What would you like me to stop doing to allow me to focus on the change you wish me to make?’ To the early adopter or enthusiast it may come as a disappointment that your primary concern is trumped by multiple confounding or competing priorities.

The problem is that this philosophy presupposes that existing ‘capacity’ is entirely value adding and being used to maximum effect. Sadly we know that for a complex array of internal and external reasons, that is seldom the case. I would contend therefore that capability rather than capacity is the real issue.​

Capability to recognise what is adding value and what isn’t. Capability to know how and when to deploy resources so not to spend time trying to fix what would have mended itself (‘intelligent intervention’). Capability to plan ahead. Capability to recognise the emergence of the conditions that give rise to harm. Capability to reduce time spent rescuing by preventing. Capability to free capacity.

The Health Foundation’s Framework for Measurement and Monitoring of Safety affords us some clues as to how we might start to recognise the gaps in our thinking. The Framework helps us to re-structure our thinking and logically develops the links between the primacy of ‘safety’ and essential elements of everyday operational management. The Framework therefore can help us to consider multiple facets of quality within the context of managing risk over time and developing real time patient safety. It can help us to develop our operational wherewithal and become more ‘capable’ of managing risk in real time and more ‘capable’ of being wise before the event.

You can find out more about the Framework and how it might work in your particular context by looking at our page on the Healthcare Improvement Scotland website.​Later we will talk more about 'intelligent intervention' and the critical importance of developing the operational intelligence to integrate and learn from safety information.